1245317205 NPI number — YOUTH OPPORTUNITIES UPHELD, INC.

Table of content: (NPI 1245317205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245317205 NPI number — YOUTH OPPORTUNITIES UPHELD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUTH OPPORTUNITIES UPHELD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245317205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 GOLD STAR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01606-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
150-845-9640
Provider Business Mailing Address Fax Number:
508-849-5618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 GOLD STAR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01606-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
150-845-9640
Provider Business Practice Location Address Fax Number:
508-849-5618
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
508-983-1300

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  4429 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000034307 . This is a "BOSTON MEDICAL CENTER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000034311 . This is a "BOSTON MEDICAL CENTER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 311121 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000034308 . This is a "BOSTON MEDICAL CENTER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18588 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 001484 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 148828000 . This is a "CHILDRENS MEDICAL CMSP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000034309 . This is a "BOSTON MEDICAL CENTER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1307665 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197401000 . This is a "CHILDRENS MEDICAL CMSP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7475389 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 106249 . This is a "MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1307665 . This is a "MBHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000020417 . This is a "BOSTON MEDICAL CENTER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000034310 . This is a "BOSTON MEDICAL CENTER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003280 . This is a "BEACON HEALTH STRATEGIES" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 802801 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 197403000 . This is a "CHILDRENS MEDICAL CMSP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 988587 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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